(Getty Images)

At first glance, you might not think that cuts to public transportation might affect someone’s health. But Devilla Ervin understands the impact firsthand. The 23-year-old lives in West Oakland and a few years ago worked the graveyard shift at McDonald’s.

“I got off work at 4 a.m. and there was no bus service,” he describes. “And so I was walking in my community of West Oakland, with shootings and violence, 45 minutes to an hour to get home.”

Yet, in addition to the threat of violence, Ervin also described a sense of social isolation that he’s felt as a result of recent cuts to bus service in his area.

“It’s not good for physical and mental health,” he says. “It wasn’t good for my spiritual health too, because I couldn’t get to church. A lot of the bus cuts were around International Boulevard where my church is.”

Access to public transportation is what policy types call a “social determinant of health” or SDOH. Health is about much more than health care, than simply seeing a doctor.

Now, in a new study, the Alameda County Public Health Department documents the link Ervin has experienced between health and access to reliable public transportation.

In the report, Getting on Board for Health, health department representatives surveyed transit-dependent riders in Alameda County. The Bay Area as a whole has experienced an 8 percent cut to bus service between 2006 and 2011.

“We found among the transit dependent riders we surveyed, more than 8 in 10 say they have more difficulty getting to their jobs, social activities, school or doctors office,” says study co-author Rebecca Flournoy. “And we know this is problem from public health” studies (for example, this one).

Flournoy, the deputy director for planning policy and health equity at the Alameda County Public Health Department says the health impacts include cumulative effects of stress and social isolation, as well as missed doctors care.

And Devilla Ervin is not alone. There are about 2 million Bay Area residents who do not have a car and are transit dependent.

The survey included 477 transit-dependent riders in Alameda County. Nearly two-thirds reported longer wait times as a result of service cuts, one-third said they had longer commutes, and about one in ten said they didn’t see friends or family as frequently. About 6 percent — mostly seniors and people with disabilities — reported less access to health care appointments.

Sheela Gunn-Cushman, a member of the Disability Action Network of Hayward, is blind and relies on buses to get around. She says there’s a clear link for her between health and transit.

“When the buses don’t run, neither do we. That means we can’t work, play, socialize things like that. And we can’t get jobs and keep jobs and and go to doctors appointments and be human,” says Gunn-Cushman.

“A lot of these residents really build their daily lives around where, when and if public transportation is available,” says study co-author Flournoy.

While other transportation studies have explored public transit health impacts in terms of physical activity, traffic safety, and air quality this is one of the first of its kind to focus on health benefits from improving transportation access.

The county health agency released the report now in hopes of influencing the draft Plan Bay Area which will go before the Metropolitan Transportation Commission (MTC) for a vote in July. The long-term plan helps determine the allocation of $289 billion in regional transportation spending over the next 27 years.

One option for the MTC’s plan includes maintaining public transportation funding at current levels. The Alameda report advocates for a different option called the “Equity, Environment and Jobs” alternative. This approach would invest more funding into services, including bus transit around the region.

(Keith Brofsky/Getty Images)

Simmi Gandhi — a family nurse practitioner at South LA’s UMMA Community Clinic — is at work early. When she calls a patient, she apologizes for waking the woman up. But she knew the woman was waiting for test results.

In Urdu, she tells the patient her mammogram shows the mass in the woman’s breast isn’t cancer. After Gandhi hangs up, she doesn’t miss a beat: She starts debriefing for her next patient, who’s been missing appointment for months.

“Looks like he has diabetes,” she says. “I had asked for him to be able to get an appointment six weeks thereafter, so that was back in September. That was cancelled, and then he didn’t come for two appointments that were rescheduled. And now he’s finally back.”

Simmi Gandhi is what’s called a midlevel provider — which includes registered nurses, physician assistants and nurse practitioners. These are medical professionals who are in-between physicians and lower skilled medical technicians and nurses. At the UMMA clinic, she provides a wide range of primary care people in need.

“A community like this has less resources,” she says. “A lot of the folks that live here have less education as I’m sure everybody’s aware, our educational system is stressed so the basic education people get around their bodies … is low.”

UMMA clinic sees many patients who have diabetes and hypertension but don’t know how to deal manage their illnesses. Doctors often come at a premium in community clinics — where salaries are lower — so midlevel providers often shoulder the workload.

In an exam room, Gandhi examines her long-missing patient, Hamdi Badar, a 52-year-old taxi driver originally from Indonesia. He’s had diabetes years, but because he’s been AWOL from the clinic, it’s now out of control.

Gandhi reminds him what poorly controlled diabetes can do. “Sometimes that can mean that you get problems with your heart, right, you remember that?” she asks him. “With your eyes? With your kidneys?”

Gandhi seems to have captured Badar’s attention. “I didn’t realize it was so bad like that,” he says.

About 2,000 patients walk into UMMA every year. Simmi Gandhi sees up to four patients an hour. Without her and her fellow mid-evel providers, UMMA couldn’t care for as many people as it does.

Five minutes away, at St. John’s Well Child and Family Center, family nurse practitioner Alexis Gomez is checking up on 74-year-old Rafael Baez. He has high blood pressure, diabetes and a history of heart failure. So Gomez questions him in Spanish  about his diet. Are you eating a lot of tortillas? No, says Baez. How about fruits and vegetables. Yes, Baez says. Gomez tells him that’s good, because fruits and vegetables are important to his diet.

Gomez has an unusual vantage point. He was a doctor in Cuba and a midlevel provider in the U.S. He sees the importance of professionals like him to fill a yawning gap in primary care.

Gomez puts it in simple terms: If St. Johns’ midlevel providers played hooky one day, it would be “a disaster,” he says.

Dr. Padra Nourparvar is the lone doctor at the same St. John’s clinic where Gomez works. He agrees with Gomez and says there’s a “always a shortage” of primary care providers in their clinic.

But Dr. Nourpavar says that doesn’t mean mid-levels can replace doctors. He says that’ll be true even as the patient load swells next year with people who’ll gain health insurance under the Affordable Care Act’s Medi-Cal expansion.

“You cannot completely substitute physicians,” he says. “Because then the quality of the care can go down. You need … [some] people with more experience and higher education to also be involved, to make sure that the quality is not compromised.”

Back at UMMA clinic Dr. Felix Aguilar its president and CEO, disagrees. ”The future is not with physicians; the future of primary care will be with what we call mid-level providers.”

Listen to the story:

It’s all that land around the prison (Avenal State Prison seen here) that carries a health hazard, the same one that affects solar manufacturers. (Buzzbo/Flickr)

Normally, you wouldn’t put “prisons” and “solar” together when thinking about a significant health problem hitting California. But the two prisons in question are in the dry, dusty Central Valley. The solar manufacturing is on huge construction sites in the California desert. Anyone who lives in those areas of California might quickly add these two clues together and come up with an answer:

Valley Fever.

Valley Fever can cause something like a nasty flu, but some people, especially those with compromised immune systems, can die. It is not contagious. Instead the illness spreads when people inhale fungal spores carried in the dirt by the wind.

California’s prison system has been fighting a losing battle with Valley Fever since 2006. In particular, inmates in two prisons along the I-5 corridor are right in harms way.

Now the federal receiver in charge of health care in California’s prisons has ordered state officials to move 3,300 inmates out, as Julie Small detailed on The California Report Wednesday morning. Inmates at higher risk include those over age 55, people undergoing chemotherapy or anyone with an illness that compromises the immune system, such as HIV/AIDS.

This move would be a “logistical nightmare” for prison officials, Small reported. The 3,300 inmates are roughly 40 percent of the two prisons’ population. Still the directive is effective immediately and has the additional headache of coming just days before state corrections officials are to submit a plan to federal court on reducing the state prison population by 9,000 inmates by the end of the year.

Meanwhile, 28 workers at two large solar power plant construction sites in eastern San Luis Obispo County have also come down with Valley Fever. As the Los Angeles Times reports, officials from the California Department of Public Health visited the sites two months ago.

This type of construction involves scraping and clearing ground to make room for thousands of acres of solar panels. Dust goes flying. From the Times:

Although respirators can prevent valley fever, workers laboring in harsh desert heat find the large commercial masks uncomfortable and are reluctant to wear them, Simonin said. He said the developer has done good job keeping dust down on the site.

The threat of acquiring the respiratory illness extends to residents living near expansive construction sites. That risk is rising given the scope of the renewable energy boom centered in the state. Scores of solar projects are planned for millions of acres across California’s Mojave Desert and elsewhere.

People who work outside — in construction and agriculture — are at highest risk of contracting Valley Fever. And incidence is way up. Over the last dozen years, cases are up nearly 800 percent, according to the CDC. 

Learn more:

Prison Health Advocates Call for More Steps to Stop Valley Fever Outbreak (KVPR)

At the Manual Arts High School Wellness Center in Los Angeles, pediatric nurse practitioner Jennie Lien gives 15-month-old Andrew Baptist a medical examination. Andrew’s great-grandmother, Yvonne Lee (right) says Andrew’s entire family relies on the center for medical care.(Photo/Chris Richard)

When Compton’s Dominguez High School celebrated the opening of a new campus wellness center last month, it was a timeless moment.

The marching band blared and thundered. Drill teams members pranced and whirled, just as they’ve been dancing and high-kicking on high school campuses for generations.

But the scene in the wellness center itself offered a glimpse of what the future could be for school medical services in California.

There was a student in for routine blood work. In the next cubicle, a mother had brought her young son, who had the flu. And neighborhood resident Jonetta Stewart, 76, had come seeking relief from frequent vertigo and headaches.

Physician’s assistant Rachel Damicali checked Stewart’s blood pressure. It was very high.

“My last patient was a 4-year-old kid, and now I’m seeing Jonetta for her blood pressure management,” she said. “So, we see a whole range: from chronic disease to urgent care visits to just physical exams.”

Just in time for the implementation of President Obama’s health care overhaul coming Jan. 1, a handful of California schools are starting to open campus-based wellness centers like the one at Dominguez, offering free and low-cost services not just to students, but to entire neighborhoods, to people of any age.

It’s part of the health overhaul’s emphasis on development of so-called “medical homes,” in which providers agree to give each patient wide-ranging medical services, with an emphasis on preventive care.

“This is better than a doctor’s office” says Jim Mangia, CEO of St. John’s Well Child and Family Center, which runs the Dominguez wellness center.

“This is comprehensive medical, dental health, mental health, enabling services, care coordination, case management, social workers,” Mangia added. “So this is a doctor’s office on steroids.”

Los Angeles Unified School District is one leader in embracing school centers. The district will have 14 of them within the year, says Kimberly Uyeda, Los Angeles Unified’s director of student medical services. To determine where to place the centers, district officials used computerized maps to identify “hot spots” for social and health ills including exposure to violence, poverty, obesity and high rates of sexually transmitted disease, Uyeda said.

Uyeda points out that students are often affected not only by the health and wellness of their families, but also by that of the broader community. “So if we don’t either address … the families and the communities, we’re only going to get so far with students.”

Money is a big issue

The school board has built the centers from bond funds. But money to keep the clinics operating is harder to come by.

The nonprofits that run the wellness centers bill Medi-Cal and other public insurance programs for the services they provide. But startup costs of up to a half-million dollars per clinic can be harder to recover. Health care advocates are lobbying Congress for support.

L.A. County Supervisor Mark Ridley-Thomas is a strong backer. As a state senator, he wrote the legislation establishing a state grant program. At the Dominguez High School opening, he vowed continued support.

“The more school-based health clinics that we build, the better this community and this broader area will be.”

Los Angeles Unified would like to keep building, too. Someday, the district would like a center on every high school campus.

Alex Briscoe, director of the Alameda County Health Care Services Agency, said it’s important to proceed carefully. Privacy is a key concern.

“If adolescents think their parents or their friends’ parents are going to be in the waiting room when they come in,” Briscoe says, “they’re not going to seek these services that have a huge stigma around them, like mental health, like alcohol and drugs, like reproductive health.”

Protecting the privacy of patients could be as simple as providing separate entrances, waiting and treatment rooms for students and the public, Briscoe said. Alternatively, the centers might only be open to the public after school hours, he said.

If such precautions are followed, Briscoe said he’s very excited about the potential for expanded services.

“We think that schools can be a center of community building if you have things that people need there,” he said.

“And comprehensive health services is a really good one.”

Listen to Chris Richard’s report:

(Getty Images)

For years, doctors, teachers and parents have fretted that attention deficit hyperactivity disorder (ADHD) is overdiagnosed and that children are overprescribed the stimulants that treat the brain disorder too often.

But, as EdSource Today reports, that’s not the case in California. According to new data from the National Survey of Children’s Health, California ranks 5th lowest in the country in diagnosis. The national average of children with ADHD is 7.9 percent, but in California, the rate is 5.2 percent.

That 5.2 percent rate may be a low one nationally. But globally, rates vary between 3 and 9 percent, “with the average closer to 5,” Prof. Joshua Israel told EdSource Today.

Still, within ethnic groups in California, the diagnosis rates drop dramatically. Kaiser researchers published data earlier this year which showed white children had a 5.6 percent rate — well in line with global averages. But other groups had much lower ADHD diagnosis rates as follows:

• Black children: 4.1 percent
• Latino children:  2.5 percent
• Asian American children: 1.9 percent

Which leads us to the question not of overdiagnosis, but underdiagnosis for some groups of children — and potentially serious consequences, says Prof. Sandra Loo, an ADHD researcher at UCLA.

From EdSource Today:

“There is a common perception that ADHD is not as severe as other disorders, when in fact the long-term outcomes of people with untreated ADHD are really horrible,” [Loo] said, including high rates of dropping out of school.

In fact, nearly one-third of children with ADHD drop out or delay high school graduation, according to research conducted at the UC Davis School of Medicine. …

To avoid over- or under-diagnosis of ADHD, the evaluation process is supposed to be thorough. Yet at every step of the way the process can go awry, subject to pressures from schools, doctors and families.

Schools are on the front lines of identifying children who may have ADHD, working with their families and doctors and creating educational plans or accommodations if necessary.

But schools do not do a uniform job in identifying children. Ruth Hughes, CEO of the Maryland-based advocacy group Children and Adults with Attention Deficit Hyperactivity Disorder, tells EdSource Today that “subtle, powerful messages in schools” can determine whether children with ADHD are diagnosed:

“The same kid who was never identified as having ADHD in one school system can move to another school system and be identified.”

Families, too, vary in their willingness to consider that their child might have a brain disorder, and their willingness to discuss the matter with teachers and doctors.

Another obstacle is that pediatricians, who make the bulk of diagnoses of childhood ADHD, typically aren’t reimbursed for the time it takes to conduct a rigorous evaluation, making the process “particularly challenging for primary care clinicians,” the American Academy of Pediatrics noted.

The need for appropriate diagnosis is considerable, researchers said, given risks at both ends of the spectrum: medicating children who don’t have ADHD or under-treating children who suffer from a disorder that may seriously impair their social and educational functioning.

“I am a researcher, but I am also a medical doctor, and I see the benefit of a carefully made diagnosis,” said Darios Getahun, lead author of the Kaiser Permanente study. “If you identify a child with ADHD in a timely way, and initiate treatment, the outcome will be better learning and better functioning in social situations.”

A factory in West Fresno. (Sasha Khokha/KQED)

It’s the first environmental health screening tool of its kind in the country.

California’s Environmental Protection Agency is rolling out “Cal Enviroscreen” which helps pinpoint communities that may be particularly vulnerable to pollution. And it’s not just for wonks. You can look up your own community. Cal Enviroscreen measures a broad range of pollutants and health indicators in every zip code across the state.

The most vulnerable community in the state? West Fresno, one of Fresno’s poorest areas. Other zip codes in the top ten include Bakersfield, Stockton and the Los Angeles-area communities of Vernon, Baldwin Park, and Boyle Heights.

But that kind of regulation doesn’t give a broad snapshot of the total environmental burden some communities face.

Cal Enviroscreen measures things like traffic, hazardous waste facilities, and pesticides. Top-scoring communities generally have high rates of air pollution and multiple toxic cleanup sites. The tool also measures population and health indicators, like poverty, low birth weight, and asthma rates.

But Alexeeff is careful to say while the tool gauges health indicators, it doesn’t imply a causal link.

“We’re using something like asthma or birth weight in this analysis, not to say the pollution is causing the asthma or the low birth weight,” he says. “Instead, what we’re saying is the community has people with asthma or seems to have a higher rate of low birth weight, and those individuals are more sensitive to pollution.”

Life in West Fresno: New Park Built on Superfund Cleanup Site

In some ways, it’s no wonder that West Fresno scored highest in the state on the index: the area is a perfect storm of pollution and poor health.

City leaders recently opened a new sports complex there, billing it a “baseball, softball, and soccer dreamland.” It also features a skateboard park, paintball, and a fishing pond.

Watching kids play, you might not realize the park is also built on a superfund cleanup site.

“This location was formerly a dump. This is what we have as a park in West Fresno,” says community activist Bob Mitchell.

The park sits adjacent to a former landfill that was actually once honored on the national register of historic places.

It was closed after regulators figured out it was leaking dangerous pollutants into the air and water. Even though the site has been cleaned up, the city still burns off methane from the landfill and monitors the groundwater for chemicals.

“We’re glad the dump is gone,” says Mitchell. “But we don’t know what the pollutants are under here. And how they may impact a child who runs and rolls around in the grass.”

Mitchell’s a retired police officer. These days he’s active with Concerned Citizens of West Fresno, which has been fighting odors from a meat-rendering plant down the street from this park.

If you were to stand up on the grassy mound covering the landfill, you’d likely see an abandoned junk yard where the state found heavy metals and PCBs.

You’d catch a glimpse of meat-processing plants, factories, and miles of orchards and vineyards, where farmers spray pesticides and the 99 freeway, pulsing with diesel trucks.

West Fresno has some of the highest rates of asthma in the state. And a recent study estimates that life expectancy here is about 20 years less than people living just across town in North Fresno.

“That is simply ridiculous,” says Mitchell. “And that is the direct result of the cumulative effect of what has been put into our community.“

Bad for Business?

While industry has been concerned Cal Enviroscreen will create more regulations, Alexeef says that’s not the goal. He says the tool is designed to help target resources. Under SB 535 25 percent of the funds raised from cap-and-trade auctions under California’s greenhouse gas laws, for example, are supposed to benefit disadvantaged communities  –- and this tool can help pinpoint those areas.

But some local leaders from LA and the Central Valley are worried the data gives too much weight to pesticides and diesel pollution.

“If you were just to look at the map, you’d think we’d have our mouths attached to the tailpipes along the [Highway] 99 corridor,” says Vito Chiesa, Chair of the Stanislaus County board of Supervisors. At first, he thought the Cal Enviroscreen tool was a good idea. After all, his constituents are always complaining the state doesn’t pay enough attention to their region’s problems.

But then, he started to worry it could backfire.

“This would be like hanging a sign at the county or the city limits saying, hey, don’t even think about doing business here,” says Chiesa.

Environmental Justice groups applaud the tool, saying it will bring needed funds to low-income communities. But they also have concerns.

“Zip codes are a very large geographic unit,” says Amy Vanderwarker, who chairs the statewide California Environmental Justice Alliance, based in Oakland.

“Within one zip code, you can have communities that are right next to refineries or power plants, and then you can have well-off communities that have good environmental conditions in their area,” Vanderwarker says.

Environmental and health activists are also worried Cal Enviroscreen also doesn’t take into account drinking water contamination. And it may not detect asthma rates in remote rural communities, since it measures asthma through emergency room visits.

Cal EPA officials received more than a thousand comments [PDF] on drafts of the tool. And they say they plan to release a version using smaller geographic units, like census tracts, later this year.

Back in West Fresno, young pregnant moms recovering from drug and alcohol addiction are listening to a health educator give them tips on taking care of themselves. The Cal Enviroscreen tool shows that this community scores among the highest in the state when it comes to low birth weight-babies.

The class is sponsored by the West Fresno Family Resource Center. Director Yolanda Randles says she’s not surprised by the grim data. But she wants to see more resources headed to her community, now.

“You’re saying in West Fresno, it’s like the worst place to live, but you’re not putting [in] any funds to help change that direction for the residents here,” says Randles.

It’s unclear just how soon Cal Enviroscreen will translate into dollars for high-scoring communities. The California Air Resources Board will consider the tool at a meeting later this week, a first step in figuring out how to allocate cap and trade money to disadvantaged communities.

Listen to Sasha Khokha’s Story:

]]> http://blogs.kqed.org/stateofhealth/2013/04/23/worried-about-pollution-where-you-live-check-how-your-zip-code-ranks/feed/ 6 Factory in West Fresno. (Sasha Khokha/KQED) http://blogs.kqed.org/stateofhealth/2013/04/08/immigrant-doctors-help-ease-californias-primary-care-doctor-shortage/?utm_source=rss&utm_medium=rss&utm_campaign=immigrant-doctors-help-ease-californias-primary-care-doctor-shortage http://blogs.kqed.org/stateofhealth/2013/04/08/immigrant-doctors-help-ease-californias-primary-care-doctor-shortage/#comments Mon, 08 Apr 2013 21:55:12 +0000 Lisa Aliferis http://blogs.kqed.org/stateofhealth/?p=12005 When Jose Chavez Gonzalez moved to the United States from El Salvador, he took any job he could get -- stocking warehouses, construction, cleaning houses and working in a meat processing plant. But unlike most of the other immigrants he worked alongside, Chavez, 38, was a doctor with eight years of medical training. He came to the U.S. in the mid-1990’s to be with his family, but like all doctors from other countries, he still had to pass the U.S. medical boards and go through at least three years of residency in order to practice here. The process can be both expensive and time consuming, so during the day he worked various menial jobs and at night he studied for the boards. Continue reading →]]> By Jenny Gold, Kaiser Health News

Dr. Jose Chavez Gonzalez examines Graciela Jauregui at Riverside County Regional Medical Center (Jenny Gold/Kaiser Health News).

It’s a familiar story in California.

When Jose Chavez Gonzalez moved to the United States from El Salvador, he took any job he could get — stocking warehouses, construction, cleaning houses and working in a meat processing plant.

But unlike most of the other immigrants he worked alongside, Chavez, 38, was a doctor with eight years of medical training. He came to the U.S. in the mid-1990’s to be with his family, but like all doctors from other countries, he still had to pass the U.S. medical boards and go through at least three years of residency in order to practice here. The process can be both expensive and time consuming, so during the day he worked various menial jobs. At night he studied for the boards.

Hundreds, maybe thousands, of immigrant doctors from Latin America could be practicing, but are instead working other –- often menial –- jobs. That’s a wasted resource.

“I had to do it. And I wouldn’t complain,” says Chavez. “It was OK to me. I mean, of course medicine is my passion, but since I didn’t have a license here, I couldn’t practice it.”

A quarter of U.S. doctors are foreign-born, mostly from countries like India that focus on training ­­medical students to work in the U.S.  Many other immigrant physicians never become American doctors, particularly those who come from Latin American countries like Chavez.

But a program at the University of California is seeking to change that, while at the same time helping to address the shortage of primary care doctors in the state. The UCLA International Medical Graduate Program offers Latino doctors a stipend along with board preparation classes, mentorship and references to help them find a good residency slot in primary care. In return, the doctors pledge to work in an underserved area of California for two or three years.

The program at UCLA was founded by Dr. Patrick Dowling and Dr. Michelle Bholat to help address the shortage of primary care doctors in the state, and a particular shortage of doctors of Latin American heritage. Though more than one-third of California’s population is Hispanic, only 5 percent of its doctors are.

In addition, nearly half of the estimated 5 million Californians expected to be newly eligible for health insurance under the Affordable Care Act are Latino, and Dowling says it’s key that patients see a doctor who understands their language and culture.

“You can either do total body cat scans on everybody or you can sit down and try to understand what the patient is saying and why and what’s going on in their life,” says Dowling.

The program is small. But slowly, it’s making a dent. Chavez was able to pass his medical exams in two years. Today, he’s hard at work as a first-year resident at the Riverside County Regional Medical Center. Most of his patients are Hispanic, and many are immigrants like him.

Graciela Jauregui came to the clinic with severe pain in her knee. She was born in Mexico but has lived in the U.S. for 17 years, working as a housekeeper. She’s 62 and doesn’t speak English. She says she always prefers to see a doctor who can actually understand her.

Speaking through an interpreter, Jauregui says, “All doctors are good people, but when they speak Spanish it’s better.”

Chavez’s fluency in Spanish is prized by his boss, Riverside’s chief of family medicine Dr. Geoffrey Leung. Leung says the clinic employs translators, but they are often in short supply. And even with a translator, important details can be lost.

“No matter how good of a translator you have, your concern is that you may lose some part of the integrity of the message,” Leung says.

So far, the UCLA program has placed 54 Hispanic doctors into family medicine training programs –- Dowling says that’s almost as many as came from all 10 California medical schools put together.

Dowling says hundreds and maybe thousands of immigrant doctors from Latin America could be practicing, but are instead working other –- often menial –- jobs. And that’s a wasted resource.

“I was just reviewing an applicant this morning who’s currently working in McDonalds,” Dowling says. “And I thought of the irony: She’s serving people Big Macs right now and what she could be doing is explaining to people that isn’t what you want you want to be eating.”

Chavez, for his part, is happy to be treating patients again: “[It] gave me the opportunity to stop working and focus full-time on studying. Without the program, I would still be working on construction.”

]]> http://blogs.kqed.org/stateofhealth/2013/04/08/immigrant-doctors-help-ease-californias-primary-care-doctor-shortage/feed/ 1 Dr. Jose Chavez Gonzalez examines Graciela Jauregui at Riverside County Regional Medical Center (Jenny Gold/Kaiser Health News). http://blogs.kqed.org/stateofhealth/2013/04/08/sex-information-teens-and-technology-ythlive-in-san-francisco/?utm_source=rss&utm_medium=rss&utm_campaign=sex-information-teens-and-technology-ythlive-in-san-francisco http://blogs.kqed.org/stateofhealth/2013/04/08/sex-information-teens-and-technology-ythlive-in-san-francisco/#comments Mon, 08 Apr 2013 18:34:31 +0000 Lisa Aliferis http://blogs.kqed.org/stateofhealth/?p=11994 In the olden days, teens and young adults who wanted accurate information about contraception or sexually transmitted diseases would perhaps find a trusted adult or sneak a book or perhaps rely on information (misinformation?) from peers. Not so much any more. Mobile apps and websites provide a range of options, and YTH.org (that's for youth, tech, health) is the focal point. Continue reading →]]>

A powerful way to reach underserved teens with credible health information say conference organizers. (okalkavan/Flickr)

In the olden days, teens and young adults who wanted accurate information about contraception or sexually transmitted diseases would perhaps find a trusted adult or sneak a book or perhaps rely on information (misinformation?) from peers.

Not so much any more. Mobile apps and websites provide a range of options, and YTH.org (that’s for youth, tech, health) is the focal point.

Its mission: To advance youth health and wellness through technology.

YTH Live kicked off Sunday in San Francisco and runs through tomorrow. The conference convenes everyone from public health professionals to youth advocates to social entrepreneurs. KQED’s Stephanie Martin talked with YTH.org executive director Deb Levine about the conference.

Here’s their conversation, lightly edited:

STEPHANIE MARTIN: On the Frequently Asked Questions section of YTH’s website, one of the questions that struck me was: “Is this conference for real?” What about this conference would prompt people to ask a question like that?

DEB LEVINE: Our conference is the only one of its kind, not only in the United States but globally. People really can’t believe that there’s a conference around youth, sex and technology. Back in the early 90s I started the first question-and-answer service around health for college students called Go Ask Alice, and 75 percent of questions on that website were about sexual health, relationships, sexual identity, reproductive health, STDs and so on. That was when we realized — almost 20 years ago — that the power of the small screen really does enable young people to ask those burning questions around their bodies and their own lives.

MARTIN: What kind of apps and other services are available to teens right now?

LEVINE: People are putting together incredible videos, teen citizen journalists, who have made videos about their own communities that you can watch on your phone. For text messaging, we have Mt. Sinai Adolescent Health Center in New York, they have a text messaging question and answer service, so you ask a question and you get an answer form a medical provider. (Editor’s note: the service, called Text in the City, appears to be in a trial phase, exclusively for teens attending the Mt. Sinai Center.)

MARTIN: Your conference addresses the popularity of texting among young people. How can that be leveraged to help them locate information and resources related to their sexual health?

LEVINE: For example, at the conference, we have mobilecommons as a representative of DoSomething.Org. DoSomething is setting up a crisis text line where young people can text any kind of question, fear or crisis that they’re going through — right at that moment — and it’s 24/7. They get texts back with conversation with a real person and the ability to connect to youth friendly services.

MARTIN: How are tech developers addressing the concerns of parents, many of whom argue that if their child is under 18 — they should be in the loop?

LEVINE: I love that question! As a parent of a tween, I’m concerned too. This is what I say to all parents: you need to know what your kids are doing online. If they download an app, then you should go and check that app on their phone. Nothing is meant to be kept from parents, but ideally this technology will help start a conversation between parents and teens about these difficult subjects.

(gernhaex/Flickr)

While there hasn’t been much research into how well undocumented Hispanic immigrants do if they are infected with HIV,  a small study from researchers at Baylor adds to what’s known — and found some surprising results.

In the retrospective study researchers reviewed the cases of 1,620 HIV-positive adults at a clinic in Houston. Researchers looked at patients’ health one year after they started HIV treatment and compared between groups — African American, white, Hispanic — with undocumented Hispanics reviewed in a separate category.

“What we found was, though they entered care with more advanced HIV,” said lead researcher Thomas Giordano in reference to the undocumented Hispanics, “actually when we looked at their outcomes they did as well, if not better, than the other groups in the study.”

Giordano says the study did not look specifically at why this might be happening, but did recount what is known about undocumented immigrants and overall health status. From the study:

Undocumented persons often endure formidable journeys to cross the US border and oftentimes work in physically demanding jobs once in the US [25]. Their sense of resilience and self-efficacy most likely differ from their native-born counterparts in the countries from which and to which they migrated. Studies have consistently shown more favorable health outcomes in foreign-born Hispanic patients and use terms such as the “healthy migrant effect” and “Hispanic paradox” in explaining this phenomenon [26]. Possible explanations include selective migration, less adverse health behaviors, and greater social support.

Kathleen Clanon, Chief Medical Officer at Alameda County Medical Center in Oakland, says that she finds Latinos are more likely to take their medication.

“Unlike our African American patients for instance they don’t have a history of concern that comes from Tuskeegee and other history in the U.S. that doctors are going to poison them or institutions are going to give them medicine that is not going to make them better,” Clanon said.

Clanon says she hopes the Baylor study will encourage more Latinos to get HIV testing and treatment. She says even Latino citizens or Latino immigrants here legally will delay care because of stigma against the illness.

The study also noted that African Americans had significantly worse HIV outcomes than all other racial groups. The research was funded in part by the Department of Veterans Affairs.

Listen to the story:

By Jane Meredith Adams, EdSource Today

Students learn how to care for their teeth and receive preventive care at a dental clinic at James Madison Middle School in Oakland. (Photo/Alameda County Public Health Department)

As California educators grapple with boosting student achievement across economic lines, the teeth of poor children are holding them back.

Hundreds of thousands of children suffering from dental disease, some with teeth rotted to the gum line, are presenting California school districts with a widespread public health problem.

Increasingly, dental health advocates are looking to school districts to help solve the crisis. Innovative oral health care projects have been launched in school districts around the state that provide students with no-cost dental screening or treatment. Insurance companies are billed whenever possible.

Dental disease is at “epidemic” levels among California children, according to the U.S. Surgeon General, and low-income children are disproportionately affected. They are 12 times more likely to miss school because of dental problems than children from higher-income families.

But many districts lack the resources, or balk at being asked to provide dental care on top of a rigorous curriculum.

“It’s a great idea to bring universal prevention programs of all types, including dental, to schools,” said Kimberly Uyeda, director of student medical services for the Los Angeles Unified School District. “Whether there’s enough time in the day is another question.”

Lost revenue

Still, schools have a vested interest in helping solve the problem.

Dental problems keep California students out of school an estimated 874,000 days a year, costing schools about $29.7 million in lost attendance based-funding, according to the 2007 California Health Interview Survey, conducted by researchers at UCLA.

Advocates say the dental health crisis is exacerbated by the failure of Medi-Cal’s dental program, called Denti-Cal, to adequately serve low-income children, lack of funding for a state school-based dental disease prevention program for low-income children, and the lack of money to enforce existing state laws requiring oral screenings and preventive care for school children.

School-based dental clinics can play a large part in the solution, given the holes in the state’s safety net. One model is to house dental care inside a school-based medical clinic. Some 61 school-based health clinics, out of about 200 in California, offer dental screening or treatment.

Outside of a school setting, finding a dentist who accepts Denti-Cal is a significant obstacle for low-income children. California’s reimbursement rates to Denti-Cal dentists are among the lowest in the nation, according to a recent report by The Children’s Partnership.

The numbers of low-income children who need care are expected to increase when the Affordable Care Act — including its Medi-Cal expansion — is fully implemented. Come January 1, nearly half of California’s children will be Denti-Cal patients, according to The Children’s Partnership report.

The implications are clear, advocates say. “You’ve got to bring the services to the children,” said Roseann Mulligan, with the USC School of Dentistry and one of the authors of the study regarding oral health and student achievement.

Reaching students

A number of districts are doing just that. Some of the dental services are financially self-sustaining through billing to insurers, while others rely on grants and partnerships. The goal is for all clinics to become self-sustaining.

Two days a week, inside the sleek new student health center housed at James Madison Middle School in Oakland, students spend about 50 minutes during physical education class period or the “sixth period” extra time in a baby-blue dental chair. A hygienist screens students for tooth decay, cleans teeth, and applies fluoride varnish and sealants. The clinic, which doesn’t provide fillings or other restorative dentistry, accepts dental insurance and Denti-Cal, and provides free service to the uninsured. Services are funded by the Alameda County Public Health Department and The Atlantic Philanthropies.

Another model is a mobile dental clinic. In the San Diego Unified School District, the La Maestra Mobile Health Clinic, which includes dental services, began operating in fall 2012 to provide fillings and restorative dentistry to students at the Hoover Cluster of schools: 10 elementary schools, two middle schools, and one high school in the City Heights neighborhood, an area of high need.

“What we are trying to do is make it a positive experience,” said Dorothy Zirkle, a consultant for Price Charities, a nonprofit dedicated to improving the quality of life for children in City Heights. “Our kids have a high need for multiple fillings. We need to build trust.”

All services are no-cost, with providers seeking reimbursement from insurers when possible. Among the organizations funding the facilities and services at the mobile dental clinic are La Maestra Community Health Centers, private foundations including the City Heights Partnership for Children, and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

A third model is a partnership with a nearby dental college to offer expanded services for students. In the El Monte City School District, students receive comprehensive dental care at two dental clinics housed in elementary schools, as well as from a mobile dental unit.

Advocates say these programs and others like them are key to helping solve the dental health crisis facing California students.

Data that show the connection between oral health and student achievement will help persuade districts to support school-based dental care, said Maryjane Puffer, executive director of the Los Angeles Trust for Children’s Health, a nonprofit founded to serve students in LA Unified.

“School districts are eager to find a way to help kids stay in school and achieve,” she said.

Learn more:

California’s Most Common Childhood Health Problem? Dental Disease (KQED Public Radio)